Hand, Foot, and Mouth Disease: Summer’s Epidemic

By Jennifer Birkhauser, MD, FAAP

It’s not a very clever name for a disease, but it gets the point across. Hand, Foot, and Mouth (HFM) disease is exactly what it sounds like: an illness that primarily affects the hands, feet, and mouth. HFM typically causes disease in children less than 10 years of age and is most commonly found in the summer and fall months.

Most HFM is caused by the coxsackievirus family. However, it may also be caused by other types of viruses, which may contribute to varying appearances and severities of HFM. What this means is that, despite its moniker, HFM may involve just one or two of the hand, foot, and/or mouth components, as well other parts of the body such as the buttocks, diaper area, knees, elbows, etc. The severity of the lesions may also range from painless, slightly reddish flat spots to painful, pus-filled blisters. Unfortunately, the existence of so many types of viruses also means that having HFM once doesn’t mean you won’t get it again!

HFM usually starts with fever and cold symptoms within a week of being infected, turns into a rash in a couple days, then resolves in about a week. Most cases of HFM run their course without any serious difficulties, though when there are complications, they are most commonly either skin infections from blisters or dehydration. The oral ulcers may be present on the roof of the mouth, gums, tongue, lips, around the lips, and further back in the throat, which can lead to significant pain when drinking and eating. When pain relief measures do not help, these patients occasionally need to be admitted to the hospital for hydration.

The fact that HFM is most contagious in the time before the rash even develops most likely contributes to the rampant nature in which it spreads within daycares and schools. Though the body rash can last for weeks, exclusion from school environments is usually only necessary during the first few days and for the duration that there are open sores.

I must admit that I know most of this from being a pediatrician, but, unfortunately, my knowledge comes from personal experience, too. My poor 2 year old son had HFM twice last year, both instances vastly different from each other. We managed to get through it fairly painlessly, but I can sympathize with parents who have dealt with it. A little over-the-counter pain relief, a decent amount of electrolyte drinks, and a LOT of love can get you a long way toward beating HFM!